MEDICARE: JALPA R PATEL D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	POD001276	GA
2	213E00000X	Podiatrist	SC006530	PA

General Provider Information

NPI Number	:	1336523166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALPA R PATEL D.P.M.

Provider Business Mailing Address
First Line	:	1975 HIGHWAY 54 W
Second Line	:	STE 205
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4794
Country	:	US
Telephone Number	:	678-561-9000
Fax Number	:	770-415-1450

Provider Business Practice Location Address
First Line	:	1716 CLEVELAND HWY
Second Line	:	SUITE 104
City	:	DALTON
State	:	GA
Zip	:	30721-2314
Country	:	US
Telephone Number	:	706-259-6882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	11/10/2017

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